By Michael Scaffidi, Meds '22
As medical students, one of the first skill sets that we are taught in the curriculum is communication. We are instructed on how best to interview patients using DISCLO TRAAAP A SOUL, PQSRT, or the Sacred Seven. We’re also taught to listen and to enter into a dialogue with patients. Sir William Osler said it best: “Listen to the patient. He [or she] is telling you the diagnosis”. While communication with patients is important, it is not the only important type of communication in medicine. We also need to be cognizant of how we communicate with each other. There is a growing evidence base – which, and this is a shameless plug, my lab has happily contributed to, showing that “non-technical skills” have an appreciable impact on patient care. One non-technical skill is that of interpersonal communication. Intuitively, this relationship makes sense, as better communication amongst colleagues leads to better collaboration and delivery of care. After all, medicine is a team effort.
And yet, how many of us many of us strive to use “effective communication” in our day-to-day interactions with one another? I know that I certainly struggle with it. By “effective communication”, I’m referring to the act of expressing oneself genuinely with one another without pretense or façade. This concept seems like common sense – after all, we all got to medical school by knowing how to behave and act in a professional manner. Nevertheless, it can be easy to fall into the trap of mincing our words or not speaking directly to our peers.
I’ll give an example from my own experience. Before medical school, I used to work in a lab. One of the constant sources of unease was discussions surrounding authorship. In particular, there was a project in which the medical student with whom I was doing the study — let’s call him Josh, approached me about authorship surrounding the paper. Josh was rather direct about it, asking me for first authorship. Josh had certainly done a great deal of work — he collected data from a number of participants and had spent hours organizing the data. At the same time, I had also done a considerable amount of work with data collection, in addition to designing the study, writing the protocol, and submitting the ethics approval.
I remember being initially taken aback by Josh’s candor. In fact, it would not be a stretch to say I was more than a little irritated with his approach. He had only been involved in the lab for two months and here he was asking for first authorship. My initial instinct was to defer the conversation indefinitely. We both had compelling reasons to vie for first authorship, but I felt that I had done the lion’s share of the work, including both the leg work of data collection and the intellectual development. So I asked Josh for time to think about it. And in that time, I wrote out a list of arguments for both sides. In the end, I decided my work had merited first authorship, but I also realized that Josh had put in a huge effort and had significantly helped advance the project. In the end, I told him directly that I thought that I should be first author, while proposing that we share authorship as joint co-first authors. Josh agreed and we completed the study together smoothly.
Looking back, however, I am thankful for Josh’s direct approach. Although I was not used to his candor, I learned that it was for the best — not only did we finish the study without a hiccup, but we became fast friends. In fact, Josh and I are close friends and colleagues to this day. Effective communication, though sometimes initially uncomfortable initially, can serve as a powerful forge for strong relationships. After all, diamonds are made under pressure!
What did I learn from this interaction? First and foremost, it’s important to be direct when expressing your needs and concerns. It would have been easy for Josh to sweep the issue under the rug and not ask in the first place. Yet, he recognized that his argument had merit and was worth bringing up. Moreover, we had our conversation in person, which minimized any possibility of misinterpretation. While email and online messaging present expedient ways to communicate, they can often unnecessarily introduce ambiguity into a conversation. Alternatively, talking with someone in person allows fidelity of discussion, as we can physically see how the other reacts to what we say.
Second, Josh approached the situation in a way that was firm while remaining respectful. Sometimes, we can fall prey to the idea that we’ll only be taken seriously if we are aggressive. While there are times when we need to take a hard-line stance, it is often the case that respectful assertiveness will go a long way in ensuring receptivity. Josh and I were extremely polite through our discussions, which ensured that we both gave the other space to hear and listen to each other.
Finally, and perhaps most importantly, there is a need for dialogue. Yes, we each have our own wants and needs. “Of course, everyone does, Michael”, you say in your head, “Are you saying that I don’t think of others?”. No, not at all, dear reader. What I am saying, however, is that it can be easy to gloss over what would best serve others for what we would like for ourselves, especially if we’re angry, tired, or stressed. And yet, putting in even a little effort to empathize with the other person can make a difficult interaction into a bearable one. In the example above, it didn’t come easy but I forced myself to see Josh’s perspective by literally writing it out. Talking with colleagues or friends for their opinion is another approach.
As I come to the end of this article, I want to end with a reflection on my ongoing journey with effective communication. As I mentioned earlier, I have done work with my lab in the area of effective communication and medicine. Although useful, this work led primarily to theoretical knowledge. I provided the example of Josh to illustrate a milestone in my practical understanding of effective communication. This understanding has only grown from having experienced effective communication among the interactions with many of my fellow classmates and friends in QMed. I am fortunate to be surrounded by many effective communicators. There were many times where misunderstandings could have easily been blown out of proportion. Yet, we were able to resolve the issues amicably because we were direct, respectful, and empathetic with one another. In other words, we used effective communication. As we move throughout our training, especially in these strange, uncertain times of the COVID-19 era and beyond, I know that we’ll need to rely on effective communication more than ever. It’s easy for tensions to run high on the wards, when life is hectic and fast-paced. However, I am confident that effective communication will help us see it through.
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